Department of Neurology, University Hospital of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.
Drugs Aging. 2013 Apr;30(4):227-34. doi: 10.1007/s40266-013-0052-5.
Stroke is a common cause of death and persisting disability worldwide, and thrombolysis with intravenous alteplase is the only approved treatment for acute ischaemic stroke. Older age is the most important non-modifiable risk factor for stroke, and demographic changes are also resulting in an increasingly ageing population. However, clinical trial evidence for the use of intravenous alteplase is limited for the older age group where stroke incidence is highest. In this article, the current evidence regarding the safety and efficacy of intravenous thrombolytic therapy in stroke patients aged ≥80 years is critically analysed and the gap in current knowledge highlighted. In summary, intravenous thrombolysis in stroke patients aged ≥80 years seems to be associated with less favourable clinical outcomes and higher mortality than in younger patients, which is consistent with the natural course in untreated patients. The risk of symptomatic intracranial haemorrhage does not appear to be significantly higher in the elderly group, suggesting that intracranial bleeding complications are unlikely to outweigh the potential benefit in this age group. Overall, withholding thrombolytic treatment in ischaemic stroke on the basis of advanced age alone is no longer justifiable.
中风是全世界范围内常见的死亡和持续性残疾原因，静脉注射阿替普酶溶栓治疗是急性缺血性中风的唯一批准治疗方法。年龄较大是中风最重要的不可改变的危险因素，人口结构的变化也导致人口老龄化日益加剧。然而，临床试验证据表明，静脉注射阿替普酶在中风发病率最高的老年人群中应用有限。在本文中，对 80 岁及以上中风患者静脉溶栓治疗的安全性和疗效的现有证据进行了批判性分析，并强调了目前知识的空白。总之，与年轻患者相比，80 岁及以上中风患者静脉溶栓治疗似乎与较差的临床结局和更高的死亡率相关，这与未治疗患者的自然病程一致。老年组症状性颅内出血的风险似乎没有明显升高，这表明颅内出血并发症不太可能超过该年龄组的潜在获益。总体而言，仅基于年龄较大而不进行溶栓治疗不再合理。
